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Frequently Asked Questions (FAQs) About SIDS and Safe Infant Sleep

A health care provider shows a computer tablet to a mother who is holding her baby in her arms.
Talk with your health care provider about any questions or challenges related to safe sleep practices for your baby.

What is the best way to reduce baby's risk for SIDS?

The best way to reduce the risk for SIDS is to always place baby on his or her back for all sleep times in a separate sleep area, designed for a baby, with no soft objects, toys, or loose bedding.

Why should I place my baby on his or her back to sleep?

Research shows that the back sleep position carries the lowest risk of SIDS.

Research also shows that babies who sleep on their backs are less likely to get fevers, stuffy noses, and ear infections. The back sleep position makes it easier for babies to look around the room and to move their arms and legs.

Remember: Babies sleep safest on their backs, and every sleep time counts!

Is a baby-sized cardboard box a safe alternative infant sleep surface?

Currently, the American Academy of Pediatrics (AAP) Task Force on SIDS indicates that there is not yet enough evidence to say anything about the potential benefit or dangers of using cardboard boxes, wahakuras, or pepi-pods.  

A firm and flat sleep area that is made for infants, like a safety-approved* crib or bassinet, and is covered by a fitted sheet with no other bedding or soft items in the sleep area is recommended by the AAP to reduce the risk of SIDS and other sleep-related causes of infant death. Keeping baby in your room and close to your bed, ideally for baby's first year, but at least for the first 6 months is also recommended by the AAP. Room sharing reduces the risk of SIDS. Having a separate safe sleep surface for baby reduces the likelihood of suffocation, entrapment, and strangulation.

You may want to consider these questions before making a decision:

*A crib, bassinet, portable crib, or play yard that meets the safety standards of the Consumer Product Safety Commission (CPSC) is recommended by the AAP Task Force on SIDS. For information on crib safety, contact the CPSC at 1-800-638-2772 or http://www.cpsc.gov.

Learn more about safe infant sleep environments.

Are baby-sized cardboard boxes subject to mandatory safety standards like other infant sleep areas?

Cardboard boxes for babies are currently not subject to any Consumer Product Safety Commission (CPSC) mandatory safety standards. These products do not meet CPSC's definition of a bassinet, crib, or handheld carrier. It is important to note that CPSC does not have the authority to pre-approve or pre-test products for safety before they are sold.

Tell the CPSC if you have any safety concerns or issues with a baby-sized cardboard box or other product. Contact the CPSC at http://www.SaferProducts.gov or (toll-free) 1-800-638-2772.

What if I fall asleep while feeding my baby?

Research shows that it is less dangerous to fall asleep with an infant in an adult bed than on a sofa or armchair. Before you start feeding your baby, think about how tired you are. If there's even a slight chance you might fall asleep while feeding, avoid couches and armchairs. These surfaces can be very dangerous places for babies, especially when adults fall asleep with infants while on them. If you think you might fall asleep while feeding your baby in an adult bed, remove all soft items and bedding from the bed before you start feeding to reduce the risk of SIDS, suffocation, and other sleep-related causes of death.

Will my baby choke if placed on the back to sleep?

No. Healthy babies naturally swallow or cough up fluids—it's a reflex all people have. Babies may actually clear such fluids better when sleeping on their backs because of the location of the opening to the lungs in relation to the opening to the stomach. There has been no increase in choking or similar problems for babies who sleep on their backs.

Illustrations showing the back and stomach sleeping positions and the placement of the infant's trachea and esophagus. Figure 1 shows the back sleep position in which the trachea lies on top of the esophagus. Figure 2 shows the stomach sleep position in which the esophagus in on top of the trachea.

When the baby is in the back sleep position, the trachea (tube to the lungs) lies on top of the esophagus (tube to the stomach). Anything regurgitated or refluxed from the stomach through the esophagus has to work against gravity to enter the trachea and cause choking. When the baby is sleeping on its stomach, such fluids will exit the esophagus and pool at the opening for the trachea, making choking much more likely.

Cases of fatal choking are very rare except when related to a medical condition. The number of fatal choking deaths has not increased since back sleeping recommendations began. In most of the few reported cases of fatal choking, an infant was sleeping on his or her stomach.

When I was a baby, I was put on my stomach to sleep. Was that wrong?

No. Caregivers were following advice based on the evidence available at that time. Since then research has shown that sleeping on the stomach increases the risk for SIDS. This research also shows that sleeping on the back carries the lowest risk of SIDS, and that's why the recommendation is "back is best."

Can I swaddle my baby to reduce the risk of SIDS?

There is no evidence that swaddling reduces SIDS risk. In fact, swaddling can increase the risk of SIDS and other sleep-related causes of infant death if babies are placed on their stomachs for sleep or roll onto their stomachs during sleep.

If you decide to swaddle your baby, always place baby fully on his or her back to sleep. Stop swaddling baby once he or she starts trying to roll over.

What if my baby can't get used to sleeping on his or her back?

The baby's comfort is important, but safety is more important. Parents and caregivers should place babies on their backs to sleep even if they seem less comfortable or sleep more lightly than when on their stomachs.

A baby who wakes frequently during the night is actually normal and should not be viewed as a "poor sleeper."

Some babies don't like sleeping on their backs at first, but most get used to it quickly. The earlier you start placing your baby on his or her back to sleep, the more quickly your baby will adjust to the position.

Is it okay if my baby sleeps on his or her side?

No. Babies placed to sleep on their sides are at increased risk for SIDS. For this reason, babies should sleep fully on their backs for naps and at night to reduce the risk of SIDS.

Can I practice skin-to-skin care as soon as my baby is born?

Experts recommend skin-to-skin care for all moms and newborns for at least 1 hour after birth, once the mom is stable, awake, and able to respond to her baby. When mom needs to sleep or handle other things, babies should be placed on their backs in a bassinet.

I saw a product that said it could prevent SIDS and keep my baby in the right position during sleep. Can I use it to prevent SIDS?

There is currently no known way to prevent SIDS, nor are there any products that can prevent SIDS. Evidence does not support the safety or effectiveness of wedges, positioners, or other products that claim to keep infants in a specific position or to reduce the risk of SIDS, suffocation, or reflux. In fact, many of these products are associated with injury and death, especially when used in baby's sleep area.

The U.S. Food and Drug Administration, the Consumer Product Safety Commission, the American Academy of Pediatrics, and other organizations warn against using these products because of the dangers they pose to babies. Avoid products that go against safe sleep recommendations, especially those that claim to prevent or reduce the risk of SIDS.

If my baby rolls onto his or her stomach during sleep, do I need to put my baby in the back sleep position again?

No. Rolling over is an important and natural part of your baby's growth. Most babies start rolling over on their own around 4 to 6 months of age. If your baby rolls over on his or her own during sleep, you do not need to turn the baby back over onto his or her back. The important thing is that your baby start every sleep time on his or her back to reduce the risk of SIDS, and that there is no soft objects, toys, crib bumpers, or loose bedding under baby, over baby, or anywhere in baby's sleep area.

What if my baby's grandparents or another caregiver wants to place my baby to sleep on his or her stomach for naptime?

Babies who usually sleep on their backs, but who are then placed to sleep on their stomachs, like for a nap, are at very high risk for SIDS. So it is important for everyone who cares for babies to always place them on their backs to sleep, for naps and at night, to reduce the risk of SIDS.

Why shouldn't I use crib bumpers in my baby's sleep area?

Bumper pads and similar products that attach to crib slats or sides are often used with the intent of protecting infants from injury. However, evidence does not support using crib bumpers to prevent injury. In fact, crib bumpers can cause serious injuries or death. Keeping them out of your baby's sleep area is the best way to avoid these dangers.

Before crib safety was regulated, the spacing between the slats of the crib sides could be any width, which posed a danger to infants if they were too wide. Parents and caregivers used padded crib bumpers to protect infants. Now that cribs must meet safety standards, the slats don't pose the same dangers. As a result, the bumpers are no longer needed.

Are there times when my baby should be on his or her stomach?

Yes, your baby should have plenty of Tummy Time when he or she is awake and when someone is watching. Supervised Tummy Time helps strengthen your baby's neck and shoulder muscles, build motor skills, and prevent flat spots on the back of the head.

Will my baby get flat spots on the back of the head from sleeping on his or her back?

Pressure on the same part of the baby's head can cause flat spots if babies are laid down in the same position too often or for too long a time. Such flat spots are usually not dangerous and typically go away on their own once the baby starts sitting up. The flat spots also are not linked to long-term problems with head shape. Making sure your baby gets enough Tummy Time is one way to help prevent these flat spots. Limiting the time spent in car seats, once the baby is out of the car, and changing the direction the infant lays in the sleep area from week to week also can help to prevent these flat spots. Check out the other things parents and caregivers can do to prevent flat spots on the back of the head. Visit the Other Ways To Help Prevent Flat Spots on Baby's Head section of the website for more information.

How old are babies who die from SIDS?

The majority (90%) of SIDS deaths occur before a baby reaches 6 months of age, and the number of SIDS deaths peaks between 1 month and 4 months of age. However SIDS deaths can occur anytime during a baby's first year, so parents should still follow safe sleep recommendations to reduce the risk of SIDS until their baby's first birthday.

What is SUID?

SUID stands for "Sudden Unexpected Infant Death." SUID is defined as deaths in infants younger than 1 year of age that occur suddenly and unexpectedly, and whose cause of death is not immediately obvious prior to investigation.  

SUID includes all unexpected deaths: those from a known cause, and those from unknown causes. SIDS and suffocation are both types of SUID. About one-half of all SUID cases are SIDS. Many unexpected infant deaths are accidents, but a disease or something done on purpose can also cause a baby to die suddenly or unexpectedly.  For some SUID, a cause is never found.

What is SIDS?

SIDS stands for "Sudden Infant Death Syndrome," and is the sudden, unexplained death of a baby younger than 1 year of age that doesn't have a known cause even after a complete investigation. This investigation includes performing a complete autopsy, examining the death scene, and reviewing the clinical history.

When a baby dies, health care providers, law enforcement personnel, and communities try to find out why. They ask questions, examine the baby, gather information, and run tests. If they can't find a cause for the death, and if the baby was younger than 1 year old, the medical examiner or coroner may call the death SIDS.

What are other sleep-related causes of infant death?

Other sleep-related causes of infant death are those that occur in the sleep environment or during sleep time. They include accidental suffocation by bedding, entrapment (when a baby gets trapped between two objects, such as a mattress and wall, and can't breathe), or strangulation (when something presses on or wraps around a baby's neck, blocking the baby's airway). These deaths are not SIDS, but they are SUID.

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